Course title :Hematology (1) Course code :MLHE-201 Supervisor :Prof.Dr Magda Sultan .Date : 5/ 12 / 2013

Outcome :The student will know :

The definition of iron deficiency anemia The diagnosis of iron deficiency anemia

Iron Deficiency Anaemia

• Iron is required for haemoglobin synthesis.

• Iron deficiency anaemia develops when the supply of iron is insuficient for the requirements of Hb synthesis .

¨ IRON METABOLISM– ABSORPTION IN DUODENUM– TRANSFERRIN TRANSPORTS IRON TO THE

CELLS– FERRITIN AND HEMOSYDERIN STORE IRON

10% of daily iron is absorbed

¨ The macrophages of the reticuloendotelial system store iron released from hemoglobin as ferritin and hemosiderin

¨ Small loss of iron each day in urine, faeces, skin and nails and in menstruating females as blood (1-2 mg daily)

¨ Most body iron is present in hemoglobin in circulating red cells

IRON METABOLISM

¨ Iron concentration (Fe)• N: 50-150 g/dl

¨ Total Iron Binding Capacity• N: 250-450 g/dl

¨ Transferrin saturation¨ Transferrin receptor concentration¨ Ferritin concentration

• N: 50-300 g/l

IRON DEFICIENCY ANEMIA¨ ETIOLOGY:

• CHRONIC BLEEDING • MENORRHAGIA • PEPTIC ULCER• STOMACH CANCER• ULCERATIVE COLITIS• INTESTINAL CANCER• HAEMORRHOIDS

• DECREASED IRON INTAKE• INCREASED IRON REQUIRMENT (JUVENILE AGE,

PREGNANCY, LACTATION)

IRON DEFICENCY - STAGES¨ Prelatent

– reduction in iron stores without reduced serum iron levels• Hb (N), MCV (N), iron absorption (), transferin saturation (N),

serum ferritin (), marrow iron ()¨ Latent

– iron stores are exhausted, but the blood hemoglobin level remains normal• Hb (N), MCV (N), TIBC (), serum ferritin (), transferrin

saturation (), marrow iron (absent)¨ Iron deficiency anemia

– blood hemoglobin concentration falls below the lower limit of normal• Hb (), MCV (), TIBC (), serum ferritin (), transferrin saturation

(), marrow iron (absent)

IRON DEFICIENCY ANEMIA

¨ GENERAL ANEMIA’S SYMPTOMS:– FATIGABILITY– DIZZENES– HEADACHE– IRRITABILITY – PALPITATION

CHARACTERISTICS SYMPTOMS

– GLOSSITIS, STOMATITIS– DYSPHAGIA ( Plummer-Vinson syndrome)– ATROPHIC GASTRITIS– DRY, PALE SKIN– SPOON SHAPED NAILS, KOILONYCHIA, – BLUE SCLERAE– HAIR LOSS– PICA (APETITE FOR NON FOOD SUBSTANCES SUCH

AS AN ICE, CLAY)– SPLENOMEGALY (10%)– INCREASED PLATELET COUNT

IRON DEFICIENCY ANEMIA¨ MCV

¨ MCH

¨ MCHC N or

¨ Fe

¨ TIBC¨ TRANSFERIN SATURATION¨ FERRITIN

BLOOD AND BONE MARROW SMEAR

¨ BLOOD:– microcytosis, hypochromia, anisocytosis, poikilocytosis

¨ BONE MARROW– high cellularity – mild to moderate erythroid hyperplasia (25-35%; N 16 –

18%) – polychromatic and pyknotic cytoplasm of erythroblasts is

vacuolated and irregular in outline (micronormoblastic erythropoiesis)

– absence of stainable iron

Assignement : Student Name

Tests for diagnosis of iron deficiency anemia

فتحي بسيوني محمودالفتاح عبد عادل مرادالسالم عبد محمد مروه

بريقع علي محمد مروهحميده مصطفي مستور

الهادي كرم مصطفيعفيفي عادل مها

محمد صالح مي

Blood morphology in iron deficiency anemia

رزق ناصر ميالدموريس ميناحجازي ندي

سعد حماده هندمحمد احمد محمود هند

حجازي عبده نجاح هندمحمود يمني

Training Questions :1.Define iron deficiency anemia 2.How to diagnose iron deficiency anemia ?

Reference book :• Essential haematology• Dacie